How to Master DME (Durable Medical Equipment) Support with Edwin Hernandez and Tedd Thomas

Think for a minute if it was your family member. You want to have the best interest of this person, this injured person, this disruptive time in their life. You want to have what's best for them. Don't rush through it. Don't try to have a favorite item or brand or whatever that you'd like for them to use. Find out what's most important to them, what's the best fit for them, what makes most sense for their lifestyle as we touched on. What a thorough understanding with everybody involved, all the shareholders involved on the claim. Welcome to another episode of It's Settled, the Amitros podcast, where you'll hear authentic stories of overcoming adversity after a life-changing injury and how injury survivors, members, and industry experts are making a difference. I'm Andrea Mills, Chief Client Officer Adam E. Troz. And I'm John Kane, Senior Vice President of Strategy. If today's episode inspires you, please subscribe and leave a review to help inspire more listeners facing similar situations. Now, It's Settled. Let's get on to the episode and explore the human side of Orders' comp and insurance claims. Today's guests are from Healthbridge Medical, and we have Ted Thomas, as well as Edwin Hernandez. And I'm gonna let them introduce themselves and talk a little bit about durable medical equipment. Gentlemen. - Hey, well, I'll jump in first, since you said my name first, John, thank you. That's just Ted Thomas. I'm the Chief Revenue Officer for Healthbridge Medical, been in the managed care industry for about 25 years. So have a pretty good feel, I think, for many aspects of it, right, the case management, the DME delivery, all those types of things. So Healthbridge specializes in nationwide DME delivery of all those plotting and services and home health services. - Hey, my name is Edwin Hernandez, Founder and CEO of Healthbridge, started Healthbridge in 2011. I've got a background in diagnostics, specifically neurodiagnostics and ultrasound imaging. Became interested in DME, in the DME space, back in around 2005, when it became intrigued with the rising cost of products and services and access to products. And then the lack of effective communication between parties that were involved in the cases, and that's what brought me to the work space. I would add here, because we're getting started, we know it's a very disruptive time, for the injured, for the claimant or the member. So we really focus on just doing, every time we touch them that we can make their day, make it a positive interaction. Our team is, we train our team a lot on that, we have formal training on that. We also talk to our technicians that are actually in the claimants or the members house, to, again, think about it, if this was a family, how you would like somebody to come in and deal with this. They're probably overwhelmed. They're not sure what to do, who to talk to, who to trust. So we just really emphasize on, maybe they just want somebody to listen, right? We just really emphasize on listening to the injured, making them as calm as possible, helping them through the process, helping them with maybe some decisions on certain items and at the end of the day, really just making them very, they know they have a trusted partner in health approach. - And I'll piggyback off of that. So you brought up something that we see quite often and that we have claimants that will conspend quite a bit of time with some of our similar associates. Some agents, some folks might frown on that because it's taking time away from the efficiency and the internal efficiencies within the business, but we actually embrace that because it allows us to build a relationship with those patients. A lot of our claimants are long-term care cases that we know we're gonna have a lot of communication with in part of building that trust is, make time to have a conversation, whether it's about the care or just a conversation related to family. And I think that helps us, that helps not only our team get to know the patient better, but it builds comfort between the patient and our care coordinators. - It's certainly a life-changing event when the person is injured and they go on to a work-ards compensation system that they're not familiar with, you know, with catastrophic cases, they have, you know, an advocate that is a nurse case manager that helps them, you know, through the process. I think it would be helpful for the audience in terms of, you know, the durable medical equipment, you know, especially in catastrophic cases. You know, what type of needs does the individual have? - Yeah, needs can be, they're very broad. And one thing about the DNA space is that you've got anything from simple to complex in order to determine what it is that the patient's going to require for their transition to the home or within the skilled nursing facility is dialogue between the provider and the referring parties. I think, you know, our team, we might see a prescription that is, and sometimes they're very, very broad, very vague. What we do is we have direct communication with the referring parties so that when those products are delivered exactly what the doctor expected and what the patient was expecting as well. - And you, I mean, you just talked about trust and, you know, it's really a partnership and not necessarily a vendor with the injured worker. They want to make sure that, you know, their supplies are delivered timely and that there isn't, you know, a disruption, you know, with their medical supplies. How do you make sure that the supplies are delivered timely? - You know, that goes back to having that communication, open communication with the claim and a lot of times what we do is once we know there's going to be a recurring order. We have, not only do we communicate with the payer, but we also have a discussion with the claim and to make sure that we're meeting their expectations. Last thing we want is the last minute rush on a Friday for a product that a patient is in dire need of because they're down to their last capital. For example, we know they live in a rural area where you don't have that Saturday delivery option and now you have to wait until Monday. We know what that can turn into. Making sure that we're communicating with the claimant often and make sure that we set a tickler and maybe a week in advance, right, to that, to that last day of the month to make sure that a patient requires not just the products are recurring but they might need some new products that we're in order. That helps us to be able to communicate that back to the payer and then keep on pace with the recurring items. - One of the things that we talked about this morning is some of the surveys. So once we onboard an injured worker post-settlement, what are some of their concerns? And part of it is understanding what's Medicare covered and what's not Medicare covered. If you give a couple examples of what would be covered versus non-covered, like maybe a shower bar or something like that. - Yeah, we do hear that a lot. And unfortunately, there's no fee schedule for instance to be able to apply to those products, or there's those random products. And I'll give you an example. Medicare doesn't have a code for a stylist. They don't have a code for a close hanger, right? But they do have codes for a cane and a walker and a wheelchair. And so those are treated, those are treated on a case by case. They don't have necessarily a cost, it's not there's no fee schedule applied to those. So for us, it's coming up with the right solution from a cost perspective with a client to make sure that they feel they're getting a fair price and that the payment feels they're getting a fair price as well. - I would add that many times when the request for service comes in, why our team is really trained to they know the type of injuries that perhaps a certain brace is being requested, but we think another brace would really work better, right, within the parameters of the script. So we talk to the patient and just get more information and that has helped a lot toward making sure the right item goes out. The first time, there's not a lot of back and forth. Again, the family setting is not disrupted or anything. So that's something that again, very important to us to kind of get more specifics on the injury that the claimant has. - Yeah, let me expand on that Ted. So Ted brings up the option within the next one. the parameters and I'll use a knee brace as an example. Often times we'll get a referral for a generic versus brand. Because we've had so much experience with these product lines, a lot of times we'll see a generic, which by the way will be coded regardless of if it's in 1933 as an example for a post-op knee brace, whether you get a generic or a brand, it's going to be inversed at the same rate. We usually, in cases, we usually choose unless we're asked not to, we will choose the brand. It's not going to cost anyone any more. And the reason we do that is because we know that the product's made better. We know we have access to a part for that product that it's required. And it's more durable. That means that the claimant is not going to have to pay for an additional brace six months down the line because it ripped apart. So there's no benefits to be able to look at a script. And not necessarily question the reason the wide-spirit tried, but maybe look at another product within those parameters so that we're providing quality. And the patient is happy with the product they're receiving. And that goes back to communication and having empathy and compassion, especially for someone that requires a knee brace, it might be hospital bed. But most of these people are significantly injured and they want to be listened to. And if you have any further examples on that. We, with regards to the transition to their own. Yeah. Yeah, you know, their life is disrupted by this catastrophic event. And then they're being taken care of it could be, it could be two months, it could be six months, taken care of by folks in a facility. And then there's the transition to the home, right? And while we sometimes think that transition to the home is something that's going to be easy off with a claimant because they are going back home, there's a part of them I think that I feel, because I've been in the care of a hospital for six months. So that transition to the home is impactful. And the reason, and why that is is because you've gone, you were injured, you went to a facility that took care of all your needs to really get the care you brought you back to health and now you're going back home, we're not going to have the same care, perhaps not by the same folks. You become accustomed to that environment, to that type of care, and to those people that you're familiar with. And when you go home and all of that changes, while it's still home, you feel a lot of source. And it becomes, sometimes it's a bit uncomfortable. It's important that the patient feels, they feel that they can trust that transition to be safe for them. And the folks that are going to be involved in that transition as well. John, and John, another aspect to your question, it's education, not only with the claimant, but with the family members, whoever else is involved here, maybe it's a neighbor, maybe somebody just comes over occasionally, they need to know the nuances and subtleties of the items, maybe they're complex items, maybe they're simpler items, but this needs to be changed, whatever, every couple days or need to do this or that, right? We make sure that we know the entire situation there with the family members that are involved, and we make sure that they get educated on helping the injured, again, to make it so everyone feels safe and secure with this new change in their life. Right. I'm sure there's a home assessment before the discharge to take a look at the house, make sure that if there's a wheelchair involved, that there's a ramp and that the home is accessible. So I don't know if there's anything else to add to that. I think it's important that the home assessment is done prior to, and sometimes you can't, sometimes you can't help, there might be a situation where the chair comes before the ramp, or the ramp comes before the chair, but sometimes what we've seen is if you don't take, if you don't have it, if there's not coordination between the groups that are providing the equipment and assessing the home, you might have a situation where as an example, you've got a patient who is, who they put a ramp, they put a ramp up into the home, it's fixed, it's the patient then arrives to the home where they chair that's two inches wider than the ramp. Now you've got a problem. So I think coordination between all parties involved is extremely important. I can't tell you how many times I've seen it where you just, the parties don't, they don't have a discussion between themselves to make sure that that transition is seamless. Yeah. There's something that both of you said that I want to go back on to, or go back to, rather. When you talked about it with the parts, and then, I think you talked about it with like making sure it's the right, you know, piece of equipment for that person, because I often think about my parents and my mom has had some, you know, medical needs and durable medical equipment needs kind of, you know, of late in the recent years. And I think sometimes people, and especially when we think about professional administration of that members' funds on our part, and making sure that they're spending their money the proper way. I also think people sometimes want that Cadillac piece of equipment, but maybe because of their technology challenges, or just maybe Edwin, to your point about, you know, that that chair doesn't fit that ramp, etc. You know, how do you all think about making sure that you're giving that person like the right equipment based on their lifestyle? And then also Edwin, you made a good point about the parts, and making sure that you're getting a piece of equipment that you know the parts will be available for. I think those are really two interesting pieces that I'd like you guys to go a little bit more in depth on. Yeah, and I can certainly do that. So health bridge has a direct contract with 200 manufacturers on the strippers. So we have access, speaking to, let's say, power chairs as an example, we have access to many brands. And some of those brands, they're side by side, the cost, there could be a huge cost difference with the same type of technology. So they're both equal in technology, right? And then you have some that if the patient does not feel comfortable enough with technology and they don't want something, they don't want the Cadillac. They still want the functionalities, but they just don't want all the bells and whistles. There's options for that as well. One thing that we think about when we provide equipment is can we service that equipment once it's placed in the patient's home, which is extremely important to cost management for that product. And three, how readily accessible are those parts? Because if the product, if there's any issue, at all with any with a tire, for instance, on a power chair or a power elevating legrest or an actuator, they were still in and we still see from time well, with so many factors, not all many factors, that certainly got a lot better. We're still seeing a lack of access to products, so two parts, for instance. So we really look at those products first that are going to be we can easily repair and the parts are readily available. So it's part of the package. You can't just look at costs for product and providing the Cadillac. You've got to look at the full picture, right? And that starts with the prescription, the patient, what those needs are, the client needs. So it's, you've got to look at the total picture. Our team does a great job of making sure that whatever product we put in the claimant hands were able to service it, one, and that those products, those parts are readily available. You don't want to have the equipment end up in a closet and not being used. You want the, you know, the DME equipment to be functional for that individual. That's right. Yeah, I tell you, if they're not, if they don't feel comfortable using the equipment, nice thing is in the past as well. I'm walking to a claimant's home where they've had several wheelchairs, a power custom power wheelchairs and custom manual wheelchairs. The reason why they're sitting off to the side is they're not easy to use. Great technology, right? But they're not easy to use, so they they put it away and they just look for something that's easier for them to operate. And so, you know, you end up spending a bunch of money on equipment, that's not, that's going to collect dust. Yeah. It's understanding the injured workers needs and and what they're really going to use. Is there anything that you're seeing kind of in the marketplace that's new for DMA that we should be aware of that's kind of some hot new items out there. We're starting to see more and more air fluidized bed systems. Not necessarily fully integrated, but we're starting to see that more and more because there's a brand in our space that has gotten out of the rental model. And so not only are they not renting to, not only are they get, did they get rid of the rental for the home environment, but most of their beds don't fit, don't fit well into the home environment either. Very large beds, very heavy beds. So we've had many claimants who live in a trailer and when you've got a piece of equipment that weighs anywhere between 500 and 600 pounds, maybe 700 pounds, it's not going to work well in a trailer. So you've got to get something that still provides the same clinical, clinical advantages, but not necessarily something that's heavy or not fitting for that environment. We were able to offer clients options where before they didn't have options. I've also seen some new technology great technology actually that's come out for power assist for custom manual wheelchairs. Custom manual wheelchairs, and I'll tell you why that's, I mean, I think that's so important is because once upon a time you had only the option of operating a custom manual wheelchair with power assist by still using the arms and shoulders and you can, you know, after a while power assist was not just because it's less cumbersome for the patient. It's easier for them to navigate and it's less stress on their shoulders, right? So when you look at some of the power assist that's come out that are adaptable to some of it. So most of these custom manual wheelchairs, there's less and less stress on the patients, on the patients of our extremities. So we've had for many years, we've had maybe one or two options and now we're starting to see three, four or five different options out there that are coming out. And some of them are adapt, they adapt right to the front of the wheelchair. And so you hold on to it no differently, you would have liked. And the front wheel basically it connects to the wheelchair with a front wheel and it's battery operated. They're able to navigate just about anywhere. So there's that sense of independence too, right? It's super important to the claimant. They don't want to be pushed around all day long or feel like they need to lean on someone. So that's, I think what comes to mind right away are those two. Ted just brought up wound, wound care. It's not necessarily that technology has changed, but there are some other options out there so you're not necessarily stuck with one particular brand. And so I think from a cost perspective, it's also been extremely beneficial to our clients to have those options. All right, that one brand just for a few seconds here is very expensive. So it would be of great interest to the members to have other options there on the on that brand, the negative pressure of wound therapy items. When there's new technology that comes out, you know, like the the bad like a hybrid wheelchair. Are there any delays by Medicare and providing coverage for those those new items? As long as you have documentation, supporting documentation, okay, supporting the equipment and the needs, this should be a reason why it's not covered. So it sounds like, you know, with the the bad and type of the injured worker, are we talking about, you know, paraplegics quadruplegics folks that might, you know, be in the bed for long extended period of times that could develop bed sores and that's why, you know, we're looking at these special T beds. That's correct. Yeah. Some of these some claimants, and I'm saying some claimants, they're not they they don't they don't embrace the air beds because it's not you're it's not I wouldn't say it's not comfortable. I've tried those out many times and some are better than others, but that immersion into it because it's an air bed and it's not meant to be at max inflate and and on the on the more stiffer side. I think that it makes the the claimants just doesn't doesn't feel that doesn't feel good to them. The off the the downside of that is when they do when they don't like it, they transfer into it every day mattress because they're going to develop rooms. Right. And so ultimately they're going to be back in a in the in the full immersion in the air bed that they're not they're unhappy with. There are you know, there are some products out there where you're not getting that full immersion. They've done, you've got and a great case studies behind it. They've got mattresses with air cylinders in them that are they provide the same type of air that skin management and they have all the properties that you would see in a low air loss mattress without without the same without the air pump running 24/7. So which is you know can be also a deterrent to them. They they don't like to hear the the an air pump running all day all night. It still provides wound management and these mattresses if if the physician and some and there are times where we offer that as as an option because we will get those claimants that say I've been in an air mattress before I don't want the pump. It's too noisy or it rattles my bed or the mattress doesn't feel well. These these beds are designed to give you those that still give you the supervised efficacy but they don't they don't have the same they don't you're not immersed in the bed so they're not as uncomfortable they're very supportive. They've got air cylinders in them they provide alternating pressure management and they're also they've got convoluted foam which is not rigid it's it's it's quite comfortable and so they're they they're very receptive to those those products as well. It it sounds like a lot you know in terms of understanding you know the the needs for the patient. I would imagine if you know a family it was trying to do this you know where they settled out their case and they're trying to self-minister their their case versus having you know support behind the scenes like professional administration where we have you know DME specialists that work with companies like yours you know helping out it must be challenging for the family. It can be challenging um and in there you know that when they when they come back home they've got so much to to worry about right settling in and while you might have some some boots on the ground to provide that support from a technical perspective it it it it's sometimes very difficult for them to take all that information in store to keep it um for use later right we're always available so our team's available uh seven days a week 24 hours a day and so there are any questions related to how a product works or even it has some challenges some challenges as to how the product works uh in the case of a low air loss mattress how to program it if there's a leak uh in a mattress and they need and they need assistance right away we're we're we're we're we're uh uh we're only gonna call away but manage the entire process I think right is really key not just making sure they got the right item but many times they they won't know what they need next or through the contact next and we we can certainly you know help with directing them you know listening to them and get them get them moving down the path uh that they need to go down and thinking through you know here at Amitros we're thinking about what happens post settlement and that people are going in for surgeries and they're scheduled and we kind of know that timeline and that time frame and kind of what will be needed a little bit after the fact you know sometimes you know there may be surprises or there'll be things that maybe the doctor's prescribing because they need it and we didn't know about ahead of time but you know pre-settlement what's also like a good time frame for you all to be notified either of like discharge or they're gonna be discharged either from a hospital or from a long-term care facility and going home you know what's kind of the sweet spot of like notification to you. I'll jump in on that and you know the sooner the better Andrea I mean if we could get at least 72 hours notice but but more notice than that will work better and then just we can make sure the proper items are good that are being requested are the ones they really need we can make sure that's there and meet you know the time frames necessary to maybe move on to the next item we can avoid unnecessary costs for the members with extravagant shipping cost and you know a lot of last-minute dropship items that if we if we have at least 72 hours notice we can avoid all almost all those things. - Yeah, and I'll add to that, since I'll, on two fronts, so we'll talk about supplies first. Many times we'll get a prescription for supplies for a patient. It'll be a very large list, right? What we've been able to do, and our clients have agreed in working with us and getting those products, at least a handful of those products. So in other words, if you've got a patient that requires, let's say, 300 catheters, rather than sending out 300 catheters and overnighting those 300 catheters, we send them out what they need for the next few days. Then get the rest of the case out to them ground, shipping to avoid those overnight next day air costs, which, as Ted said, they're extremely high. So that's one. The other is 72 hours is great. When Ted said a little, even longer would be better. That's particularly important when the patient leaves with prescriptions for custom products. Physicians will write out prescriptions for a custom razz, I'll use a razz shower chair, for instance, re-upshower chair. Well, a razz re-up shower chair cannot be shipped overnight. You've got activated who, their products are made to order. So, made to order means that it's five to seven days minimum for them to go through production and then they need to ship. And they're bulky. So, the overriding something like that is going to cost you an arm and leg. For us, on the custom products, I would say if you've got about two weeks, notice if we can get, particularly on the custom products, on the heavy lifting, and that would be like the hospital bed, specialty hospital beds, lifts, that sort of thing, we would want more time because we want to coordinate either with the manufacturer who are getting the product from a technician on the ground, is going to be receiving the product, so they can coordinate with the family, the delivery and the setup. Or if you've got custom products that need to be made, that are going to be managed differently, we also have some opportunities to with certain manufacturers to be able to get them to maybe process something sooner for us, but it's very rare because everyone's after the same thing, they want the product yesterday. But there are times when we might be able to pull some strength, but it's rare. So, with the custom equipment, it could be a little more challenging, and so two weeks would work well for the supplies, the easy dropship, I would say within 72 hours is very fair. - That makes a lot of sense. Just that of curiosity, why would you need a custom shower chair versus the old plastic and metal ones that I feel have been in my grandmother's house for years? - That's a great question, and that's because if you have a paraplegic that requires a bathing system, like a re-op shower chair that tilts back for hygiene, they cannot manage their baths themselves. Or they can, and they use the shower chair to get out of bed into the shower chair and into the shower. These claimants are going to require some type of tilt, or even if it's not tilt, some type of re-op shower chair. These re-op shower chairs come with a special seat, they call it keyhole, and basically have openings either to the right or the left or the front, and that's for personal hygiene. So there are a lot of advantages to a custom re-op shower chair, or just a re-op shower chair in general. - Gotcha, that makes a lot of sense. Interesting. I think also one other thing I was curious about is if I'm a new claims handler listening to this podcast, or I'm a new employee to Amitros, and I'm dealing with an injured worker that's getting discharged or an injured worker coming home from surgery and needing equipment. What are some tips you would give that adjuster for, let's say, empathy and checklist and things like that? - I'll jump in for a second, Edwin. I think it would be, it's a lot easier when an adjuster can go to one resource to get all the items they need, right? Because then if you don't, you're managing multiple resources and you're not remember which partner told you which item was coming in earlier, which items still needed to be delivered. So a big tip I would give for an adjuster just starting out doing this is find organizations that you trust, that you know, you're gonna do a good job for your patient, have the experience, and that can get as many of those, access to as many of those discharged items as possible, then you just have one group to interact with to make sure that all those items are either being delivered or on their way to being delivered. So great, but much better use of the time for the adjuster. - Awesome. - So Ted and Edwin, we've been talking a lot about the equipment, safety, make sure if it needs to be customized, there's a lot to this. And I'm sure with wheelchairs, especially with people that might be morbidly obese, that there's fittings that are associated with that. Can you talk a little bit about the customized and the fitting behind the equipment? - Yeah, so it's not a one size fits all so you do have to have an assessment. It would require an ATP, and perhaps even an OT of their involved in the patient's care as well as the facility. Court made a visit so that the ATP could be on site, measure the patient. Maybe you didn't have a sample chair. If we have the patient's height and weight, we might have a chair, the ATP might have a chair that they can bring out. And so the features and benefits, the claimant, kind of explains exactly why they're being fitted for the chair. And so the post fitting is just as important too, because the fitting of the chair, the actual fitting of the chair, rather, is where you make all the necessary adjustments. One of those adjustments would be the bucket, creating bucket in the chair, and that's the drop in the back of the seat where the patient, when they sit down into the chair, they're sitting in comfortably into the chair. And so that fitting after the chair's been delivered by the ATP is extremely important. If not just as important as the actual first visit where the measurements are taken. - In for our listeners, ATP. - ATP stand is short for assisted technology professional. - Thank you, I appreciate it. Yeah, so it sounds like it's, you know, a lot of work to make sure that the person is properly fitted and, you know, they feel safe with the equipment, as well as, you know, we talked about, make sure they're using it, right? - Correct. - Yeah, I would just sum up the, you know, our approach and whoever is dealing with the claimant is, you know, just think for a minute if it was your family member. Right, you wanna have the best interest of this person, this injured person, this disruptive time in their life, you wanna have what's best for them, you know, don't rush through it, don't try to, you know, have a favorite item or brand or whatever that you'd like to, for them to use, you know, find out what's most important to them, what's the best fit for them, what makes most sense for their lifestyle as we touched on, you know, what a thorough understanding with everybody involved, all the shareholders involved on the claim, you know, what, get all that information of front, John referenced earlier about, about making sure we ask a lot of the questions up front. Well, that's exactly what you need to do when you need to listen and again, not one size doesn't fit all, this is very nuanced things that you do up front and takes a lot of experience, right, to make sure that you're listening to the keys and the clues that are being told to you, to make sure that you get out the perfect item for this, for this person, for this injury. - Ted and Ann, when we, we certainly appreciate, you know, your information, the insights and how we can make this easier for, you know, the injured worker with respect to their, their DME and a, you know, a safe return home. So, you know, on behalf of METROs and it settled, thank you very much, we appreciate your time. - We appreciate you. - Thank you. - Thank you both. - Thanks for listening to It's Settled, the METRO's podcast. Find us on major streaming platforms, like Apple Podcasts and Spotify. Your review means a lot to us. It helps us share these inspiring stories with more listeners. For more information about a METROs, please visit our website at ametros.com. That's AMETROS.com. - It's a big shout out to our amazing guests for sharing their experiences and to our dedicated podcast producer, Melon E. Samarron. Join us in our next episode. next episode for more uplifting stories, it settled on to the next time. Stay inspired and continue making positive impact.